Patient and financial support

Support to help your patients with moderate to severe endometriosis take a next step

Access to new products

Broad formulary access for new products builds over time. Initial coverage delays may be experienced as insurance companies review internal protocols

ORILISSA is available via retail pharmacies

Send ORILISSA prescription to the patient’s preferred retail pharmacy, as with most products you prescribe.
Formulary access builds as payors recognize physician request and the unmet need for the product. Prior authorization may be required for ORILISSA. In some cases, a medical exception may be required.
Set expectations with patients that there may be initial approval delays for new products.*

*When setting expectations with patients, please remember to never guarantee coverage of ORILISSA.

Ori for Me ORILISSA patient financial support

ORILISSA Savings Card^†

Eligible patients may pay as little as $5 a month with the ORILISSA Savings Card.^†

Patients can activate their savings card by visiting ORILISSA.com/savings.

Select number of savings cards to download:

Or send your patients a link to sign up for an ORILISSA Savings Card.

Send patients sign-up link

Complete form below
to send email

Please complete all fields:

First name:

Last name:

Email address:

I am authorized to use the above patient's contact information to send manufacturer-provided disease awareness and patient support information.

If you continue to experience challenges with initial access to ORILISSA, Ori for Me offers additional resources to support patients with prior authorizations and appeals. AbbVie may be able to help eligible patients with options for expedited access to ORILISSA.

Benefits verification

Verify coverage for ORILISSA

Information for prior authorization processing

Provide information on prior authorization for ORILISSA

Information for medical exception requests and appeals (if necessary)

Provide information on submitting medical exception requests and appeals

Patient Assistance Programs

Help patients with limited resources access ORILISSA through Patient Assistance Program^‡

There are many ways for your patients to enroll in Ori for Me

Call

1-844-674-3676
(1-844-OriForMe)

Fax

1-833-674-5477 (ORILISSA) (physician only)

Download enrollment form

Download the Ori for Me Free Patient app

(Available Fall 2018)

Go online

Visit ORILISSA.com

If your staff has questions about your patients’ ORILISSA prescriptions, they can call us at 1-844-674-3676 (1-844-ORIFORME) or visit ORILISSA.com. We’re here to provide your practice with the support and information you may need about ORILISSA.

^†Available to patients with commercial prescription insurance coverage for ORILISSA™ (elagolix) who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the ORILISSA Savings Card and patient must call Ori for Me™ at 1-844-OriForMe (1-844-674-3676) to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from Ori for Me from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums (maximum benefit of $200), may apply. This is not health insurance. Please see full Terms and Conditions.

Use our Medical Exception Resource to help patients get started on ORILISSA